If you’ve recently received a diagnosis of osteopenia following your DEXA scan, you likely have questions about what this means for your future bone health. Like many people diagnosed with this condition, you want to know if osteopenia can be reversed, and whether you can avoid progressing from osteopenia to osteoporosis.
As a physical therapist specializing in this area, I can assure you that with proper intervention, many people can improve their bone density and bone quality. They can slow the process of bone loss and, potentially, reverse their osteopenia. Let’s get you started on the path to building better bones.
Can Osteopenia Be Reversed?
Thankfully, you can be proactive and prevent your osteopenia diagnosis progressing to osteoporosis. The key is to follow a program that improves bone density and bone quality.
Patients often ask me if osteopenia is reversible. While some people manage to regain bone density and reverse osteopenia, I encourage clients to set realistic goals and focus on slowing down bone loss and preventing osteoporosis. I advise them to consider the diagnosis of osteopenia as a wake up call as well as an opportunity to improve their bone health before things get worse.
Most are never told by their doctor that they have osteopenia. Many physicians have limited time and are unable to give you the attention you need to manage osteopenia. For most physicians osteopenia is not seen as a red flag. So they do not raise it with their patients.
Sadly, many physicians wait until the diagnosis of osteoporosis to take action. The tools they have at their disposal is pharmaceutical intervention.
Before we dive into all of the great things we can do for the health of our bones, let’s cover the definition of osteopenia so that we’re all on the same page.
What Is Osteopenia?
The “gold standard” for diagnosing osteopenia is a bone mineral density test using a machine called a densitometer, commonly known as a DEXA scan. These tests became available in 1987 and have been our main tool for assessing bone health ever since.
When you get your results, you’ll see the bone density of your spine, hip and femoral neck (the upper part of your hip) measured in g/cm², but what doctors focus on is your T-score. This score compares your bone density to that of a healthy 30-year-old woman.
Since 1994, here’s how we categorize these scores based on standard deviations away from normal:
- Normal: T-score above -1
- Osteopenia: T-score between -1 and -2.4
- Osteoporosis: T-score below -2.5
There’s also a newer assessment tool called Echolight REMS that similarly provides T-scores for your spine, hip and femoral neck.
Your BMD score is just one piece of information about your bone health. It tells you the density but not the quality of your bones. More on bone quality later.
Evidence Based Guidelines for Treatment for Osteopenia
The diagnosis of osteopenia is NOT necessarily an indication for pharmaceutical intervention. I suggest that it is a great opportunity to make your bones as resilient as possible.
Many clients with osteoporosis or who have already fractured wish that they knew they could have made changes sooner. Don’t wait until your doctor tells you that you have osteoporosis and that you need medication! You can start making your bones stronger today and reduce your risk of developing osteoporosis and potentially reverse osteopenia.
Effective osteopenia treatment guidelines include the following major components.
Targeted Osteoporosis Exercise Program for Osteopenia
Weight-bearing and strength training exercises are crucial for stimulating bone formation:
- Weight bearing exercises: Activities like walking, jogging, dancing, and stair climbing force your body to work against gravity, which stimulates bone-strengthening cells.
- Strength training: Using resistance bands, free weights, or weight machines helps build muscle strength and stimulates bone growth at the attachment sites of muscles to bones.
- Balance training: While this doesn’t directly build bone, improving balance reduces fall risk—a critical factor in preventing fractures.
The most effective exercise programs include progressive strength training 2 to 3 times per week combined with regular weight-bearing activities. Research shows that site-specific exercises can improve bone density in targeted areas, particularly the spine and hip. Shorter high-intensity activities are more beneficial for bone strength.
Optimal Nutrition Program for Osteopenia
Your bones need specific nutrients to build and maintain strength:
- Calcium: Women aged over 50 need daily food sources rich in calcium like dairy products, fortified plant milks, leafy greens, and fish with edible bones.
- Vitamin D: Essential for calcium absorption, aim for 800-1,000 IU daily. Your body produces vitamin D when exposed to sunlight, but supplementation is often necessary, especially in northern climates.
- Protein: Adequate protein intake supports bone matrix formation.
- Magnesium, vitamin K, potassium: These nutrients work synergistically to support bone health and are found in fruits, vegetables, nuts, and seeds.
Whole foods provide the best combination of these nutrients in forms your body can efficiently use.
Lifestyle Modifications
Several lifestyle factors significantly impact bone health:
- Limiting alcohol consumption: Keep alcohol intake to one drink or less per day.
- Avoiding smoking: Smoking impairs blood flow to bones and interferes with the production of bone-forming cells.
- Maintaining healthy weight: Being underweight increases fracture risk, while excess weight puts additional stress on bones.
- Controlling blood sugar levels.
Osteopenia Prevention and Treatment
Your goal should not be to reverse osteopenia by achieving a specific T-score, but rather to build stronger, more resilient bones that reduce your overall fracture risk. Don’t wait until osteoporosis develops and medication becomes necessary. Start implementing these bone-strengthening strategies today. Your future self will thank you for the foundation of support you’re building now.
Exercise Recommendations for Osteoporosis
Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.
But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?
A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.
I cover important topics related to osteoporosis exercise including:
- Can exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis exercise program.
- Key principles of bone building.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength important if you have osteoporosis?
Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.
Osteopenia, Bone Density and Bone Quality
Most of us never think about our bones until we break one. We assume they’ll be there as our foundation of support for life.
But here’s what’s important to understand: a bone density test tells you just that—the density of your bones. What about the QUALITY of your bone and why does this matter?
The combination of bone density and bone quality determines your overall fracture risk.
Osteopenia and Fracture Risk
This is where the Fracture Risk Assessment (FRAX) calculation comes in. It measures fracture risk when you have osteopenia. (1)
The FRAX should accompany any bone mineral density test result for someone in the osteopenia range, as it provides insight into bone quality and overall fracture risk. Many of the questions on the FRAX are risk factors you cannot control. Let’s take a look at these next.
Risk Factors of Osteopenia Outside Your Control
Here is a list of risk factors of osteopenia you CANNOT control:
- Genetics, if your parent had a hip fracture this is a red flag
- Previous fragility fractures, where your bone breaks from a slip or fall from standing height or less
- Having a fragility fracture in the last year
- A history of eating disorders, malabsorption or nutrient deficiencies
- Menopause younger than age 50 and long periods of amenorrhea (skipping menstrual periods)
- Glucocorticoid use for longer than five months
Sadly, you cannot go back in time and change any of these things that may have led to lower bone quality and density. You can however, still make changes to a number of factors in your life that can have a significant impact on the health of your bones. Let’s take a look at these below.
Risk Factors of Osteopenia Within Your Control
Here are the risk factors of osteopenia (and bone health) you CAN control:
- Diet: Rich in protein, vegetables and fruit, adequate vitamin D, calcium and other essential minerals.
- Reducing and/or eliminating highly processed foods, including many “fast foods”
- Smoking.
- Alcohol intake. Moderating your alcohol intake to one a week.
- Controlling your blood sugar
- Participating in regular, safe and progressive strength training
- Incorporating daily weight bearing exercises and activities appropriate for your fracture risk
Your bones build more easily when you are in the osteopenia range rather than osteoporosis range. Studies have shown that women with osteopenia who did the exact same exercises as the women with osteoporosis were able to make greater gains, all else being fairly equal.
A 2023 meta-analysis on jumping showed that women with osteopenia gained bone at the hip and spine whereas those with osteoporosis only gained at the hip. (2)
Osteopenia and Fractures
Here’s the surprising fact that your doctor may not tell you: Most fractures occur in people who have osteopenia, not osteoporosis. (3)
A 2024 paper titled Osteopenia: a target for fracture prevention (3) highlights that “the importance of the osteopenia label for diagnosis and treatment is often unclear and misinterpreted.”
Many individuals who have experienced bone loss with bone density scores in the osteopenia range are simply told “all is good” without being informed that their bone loss can increase their risk of a fracture.
Osteopenia: Hip, Femoral Neck and Spine
Many of my clients ask me for specific exercises for their hips, femoral neck and spine because osteopenia is detected in one or more of those areas. I encourage all my clients to have a well rounded program that takes all their bones into consideration.
Our skeleton is made up of two types of bone: cortical and trabecular. The cortical bone is hard and more resistant to fracturing. Trabecular bone is softer and composed of thousands of trabecular or cross links. As such, trabecular bone can fracture more easily.
A DEXA test measures your hip and spine because those bones are composed of a relatively high percentage of trabecular bone. Having osteopenia or osteoporosis increases your risk of fractures of the spine (vertebral body) and the femoral neck (part of the hip).
Along with the ends of the long forearm bones, the bones of your hip and spine are more vulnerable to breaking if your fracture risk is elevated. Testing your hip and spine is a leading indicator of overall bone health. Bone density and bone quality scores provide early warning that something needs to change to stop your bones from becoming further at risk of fracturing.
In the next section we discuss an overlooked modality to improve bone health in women: hormone replacement therapy or HRT.
HRT and Osteopenia
Women have a lot going on in their lives around menopause. Hormonal changes can reduce your sex drive, cause vaginal dryness, weight gain and hot flashes. Mood swings and sleep problems are also on the list of issues that our hormones influence.
Unfortunately, one of the least spoken symptoms of menopause is bone loss. Due to the drop in estrogen and progesterone, women will rapidly lose bone in the first five years after menopause. Studies have shown that fifty percent of bone loss that will occur between the start of menopause and age 80 happens in the first 5 years after the start of menopause.
Hormone Replacement Therapy and Osteopenia
Hormone replacement therapy, HRT, has come a long way in the past 25 years. HRT is an option that can help reduce many of the symptoms mentioned above, including bone loss. The dosage may change as you age but clinical data have shown that women can maintain more robust and resilient bodies while on hormone replacement therapy into their 90s.
Armed with this knowledge you may wish to connect with a gynecologist, endocrinologist or any doctor in your community versed in hormone replacement therapy (HRT). So long as you do not have a family history of estrogen dependent breast or ovarian cancer, hormone replacement therapy is a safe and effective option for your bones. For those of you at risk for cancer there is another option.
Selective Estrogen Receptor Modulators (SERMS) and Osteopenia
The most widely used SERMS is Raloxifene (Evista). It selectively mimics estrogen’s beneficial effect to bone and not to our breasts of ovaries.
Over the last quarter of a century few North American doctors received training in HRT while in medical school. Today doctors around the country are coming to realize the harm this has caused women. Some have taken extra training to be able to understand and prescribe HRT.
If you are unable to start HRT or use SERMS, remember there are still many things you can do to reduce your risk of having a fracture.
Monitoring Your Progress
Following your osteopenia diagnosis, your physician will likely provide the following medical advice:
- Repeat DXA scans every 1 to 2 years to monitor changes in bone density
- Regular check-ins to assess your osteoporosis exercise program and nutrition
- Height measurements to detect any compression fractures
Success looks different for each person. For some women, completely reversing osteopenia and returning to normal bone density is possible. For others, success means halting bone loss and preventing progression to osteoporosis.
Osteopenia and Sarcopenia
Both osteopenia and sarcopenia can affect us as we age. However, they are very different. Sarcopenia affects muscle mass, specifically it is the gradual loss of muscle mass and strength that occurs as we age. Osteopenia, on the other hand, affects our bone health.
I do not need to elaborate more on sarcopenia in this post because I have written blog posts on preventing sarcopenia and exercises for sarcopenia elsewhere on my site.
Conclusion
An osteopenia diagnosis represents an opportunity to take control of your bone health before more serious problems develop. With a comprehensive approach that includes targeted exercise, optimal nutrition, healthy lifestyle choices, and appropriate medical intervention when necessary, many women can improve their bone density and reduce fracture risk.
Remember that consistency is key—the bone remodeling process takes time, and improvements in bone density may take 12 to 18 months to appear on scans. Stay committed to your bone health program, and work closely with your healthcare team to optimize your results.
Your bones support you every day—now is the time to support them.
Margaret Martin
Further Readings
References
- Zerikly R, Demetriou EW. Use of Fracture Risk Assessment Tool in clinical practice and Fracture Risk Assessment Tool future directions. Womens Health (Lond). 2024 Jan-Dec;20:17455057241231387. doi: 10.1177/17455057241231387. PMID: 38529935; PMCID: PMC10966972.
- Florence G, et al. Skeletal site-specific effects of jump training on bone mineral density in adults: a systematic review and meta-analysis. Journal of Sports Sciences. 2023 Dec;41(23):2063-2076. doi: 10.1080/02640414.2024.2312052. Epub 2024 Feb 2
- Reid IR, McClung MR. Osteopenia: a key target for fracture prevention. Lancet Diabetes Endocrinol. 2024 Nov;12(11):85
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